Facing COPD With Pulmonary Rehab

A relatively new approach is helping lung disease patients improve their quality of life.

By Dr. Sanjay Gupta

For more than 15 million Americans, chronic obstructive pulmonary disease
(COPD) makes even routine tasks exhausting. Ann Braz, who was diagnosed
with COPD in 1997, knew something was wrong when she became short of breath
climbing stairs. “I went on a Bible study retreat, and we had to walk up a
bunch of steps to our rooms while carrying our luggage,” she recalled. “I was
huffing and puffing a lot compared to the other gals. That’s when it began to
worry me.”

COPD refers to a group of lung diseases, including emphysema and chronic
bronchitis, that cause “an exaggeration of the natural aging process of the
lung,” said Richard S. Novitch, MD, director of cardiopulmonary rehabilitation
at Burke Rehabilitation Hospital in White Plains, N.Y. “Each individual is
different, and the illness presents differently in them,” said Dr. Novitch. For
patients like Braz, pulmonary rehabilitation can play a central role in
managing the illness.

“A friend of a friend told me about pulmonary rehab,” said Braz, 66, who
lives in Fredericksburg, Va. “I called Norfolk General Hospital, and asked if I
could enroll in the program and pay for it myself.”

Pulmonary
rehab is a relatively new approach to COPD management, and “it’s starting
to get more recognition for how much it improves quality of life,” according to
Ashley Henderson, MD, assistant professor of pulmonary and critical care
medicine at University of North Carolina School of Medicine. The treatment
combines exercise training, nutrition counseling, breathing strategies, group
therapy, and energy-conserving techniques in a personalized program based on a
person’s symptoms and abilities. “It’s very patient-specific,” said Dr.
Henderson. “That’s why it’s great.”

Patients typically attend sessions multiple times a week for four to 12
weeks, depending on the severity of their condition. “We look at their walking
tolerance, breathing patterns, strength, flexibility, oxygen needs, and more,”
said Tricia Agnoli, a physical therapist and coordinator of the University of
North Carolina Pulmonary Rehabilitation program. “Then we work on improved
walking, overall endurance, and strength, all with a plan to transition them to
independent exercise routines and keep them healthy and out of the hospital.”

Dr. Henderson points out that even if a patient can’t handle walking on a
treadmill, they can do arm exercises to improve cardiovascular health and build
up muscles near the chest. “The heart can compensate for what the lungs can’t
do,” said Henderson. “They may not be able to do a marathon, but they can walk
a half mile.”

“With COPD, your body is demanding more oxygen and the stronger your body
is, the less oxygen it will demand because you can use your new strength to
help compensate,” said Braz.

Education is a key part of pulmonary rehab. “We had nutrition education,
stress therapy, learned breathing techniques,” said Braz. “A pharmacist came
and spoke to us about the medications we were taking.”

The treatment also helps COPD patients manage feelings of anxiety and
depression that often accompany their condition. “Support groups are
lifesavers,” said Braz. “People realize they’re not alone out there and can
help each other understand the disease.”

As Henderson points out, going to rehab sessions “forces people to get out
of the house and do something and interact with other people.”

According to a recent study, at least 40 percent of people with COPD suffer
from depression. “Depression is shown to be a risk factor for mortality in
COPD,” said Joshua Diamond, MD, a pulmonologist at the Penn Lung Center in
Philadelphia. “To help with this, we need to focus on improving
quality of life, and pulmonary rehab can cause a dramatic improvement
there.”

While most COPD patients can benefit from pulmonary rehab, not everyone has
access to a program nearby. The American Association of Cardiovascular and
Pulmonary Rehabilitation provides a searchable directory on its website,
where people can find pulmonary rehab programs by state.

“The goal with pulmonary rehab is to improve a person’s level of
conditioning so they can do more with whatever limited lung function they
have,” said Dr. Diamond. “It’s currently an underutilized intervention, but hopefully
it will become more commonplace as people often develop a dramatic improvement
in their quality of life.”

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